2023 Roundtable Registration Form

ICDVVA Regional Roundtable & Training Registration Form

Hosted by the Idaho Council on Domestic Violence and Victim Assistance
Name*

First NameLast Name
E-mail*
example@example.com
Job Title*
Organization*
Is your organization currently funded by ICDVVA?*

YesNo
Please indicate which Roundtable Training you will be attending:*

Region 1 & 2: August 9th, 2023Region 6 & 7: September 19th, 2023- Idaho Falls Activity Center, South RoomRegion 3,4, & 5: November 8th, 2023
For funded programs, the afternoon session is required but the morning training is not. Please indicate if you plan on attending all day, or just the afternoon:*

Afternoon session onlyAll day
Please let us know of any accessibility accommodations:
Should be Empty:

ICDVVA Regional Roundtable & Training Registration Form